Gifts

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Helen Haddich, Homeland Hospice Nurse, has a gift of expression. We are grateful to her for allowing us to share the following article from her blog “From Saving to Sending, Hospice Isn’t Just About Dying.” Prior to becoming a Hospice Nurse, Helen’s journey included ten years of being a Med Surg, ICU, and Perianesthesia Nurse.

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Anyone who knows me, knows I am not so great at wrapping gifts. Don’t misunderstand me, I am a great gift giver. I take the time to think and plan each detail of the gift. The rush knowing how much the receiver will ultimately love the present makes the effort of wrapping so totally worth it.

It is Christmas Eve … the tree is dressed in its brightest … the presents are tucked neatly around. The glow of the lights is mesmerizing and has me lost in thought. Being a hospice nurse is full of experiences that sometimes take time to process. It is emotional blender of thoughts and feelings. But, one undeniable truth is that for all of its difficulties, it presents so many different gifts, each so valuable but, not one more so than the next.

Thank you for the gift of understanding – for teaching me to open the eyes of my heart and not make snap judgements.

Thank you for the gift of humility – for allowing me to see people, who are in the valleys of their lives and put aside their pride to ask for help.

Thank you for the gift of forgiveness – for showing me that regardless of whatever the rift, fight or misunderstanding, of you truly want to forgive, it can be done.

Thank you for the gift of hospitality- for allowing me to come into your home and even though you are dying, you ask me if I want something to drink or eat.

Thank you for the gift of love – for allowing me to witness as you watch your husband slip away while you, through tears, thank him for allowing you to love him.

Thank you for the gift of honesty – for opening my eyes to the true meaning of baring your soul – flaws and all.

Thank you for the gift of hope – for that little spark that still glows like embers with the secret wish that health may find its way back.

Thank you for the gift of appreciation – it goes without saying that I take so much less for granted. The fact that I can open my eyes in the morning is truly a gift.

Thank you for the gift of acceptance – we might be different shades, different backgrounds and have different beliefs, but, you accept me wholeheartedly in your homes

Finally, thank you for the gift of just simply allowing me to care for you. It is such a profound honor beyond words. Each patient finds a way into my heart, staking their own spot. Hospice has brought me so many gifts and experiences that no matter what I do, it will never even approach. The scales are horribly unbalanced in my favor.

The gifts of hospice don’t come wrapped in boxes and are often not even tangible. They can’t be purchased or ordered. The gifts of hospice are never ending and last a lifetime. They stay locked safely in my heart, never to be broken or taken. How can I ever express gratitude? The truth is I can’t, but, will spend forever trying.

Homeland Hospice serves 14 communities throughout Central Pennsylvania by providing end-of-life care either in a person’s home or wherever they reside, including nursing facilities. Homeland Hospice also provides bereavement support to families for a full 13 months following the death of their loved one. This service is available to anyone in the community who is experiencing grief.

To learn more, please contact Homeland Hospice at (717) 221-7890.

Holiday Gatherings are a Great Time for Advance Care Planning

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Editors Note: First published at csupalliativecare.org, we thank the Shiley Institute for Palliative Care for giving us permission to reprint this important and timely article.

Experts say ‘Tis the Season to Talk with Family about Healthcare Wishes  

When parents, grandparents, aunts, uncles, cousins, and other family members gather around the holiday dinner table, conversations are typically sprinkled with small talk about the weather, football scores, and the latest gift-giving trends.

Rarely, though, do families address perhaps the most important subject for any adult – especially older adults with a serious health condition such as cancer, lung disease, or heart failure. What matters most to them in the time they have left on earth? How do they feel about invasive life-sustaining measures such as life support that might only prolong the inevitable? What kind of medical care would they want if they are no longer able to speak for themselves?

Discussing these healthcare decisions and the values that guide them is called advance care planning – and the best time to do it is now, experts say.

While such talk may seem at odds with the festive spirit of the season, the holidays are actually the perfect time for end-of-life discussions, said Sharon Hamill, PhD, a professor of Psychology at Cal State University San Marcos who has done significant work in the area of advance care planning. Hamill is the former and founding director of the CSU Shiley Institute for Palliative Care at Cal State San Marcos, a campus partner of the CSU Shiley Institute for Palliative Care.

How to Start the Conversation

Dr. Hamill said talking about personal values, quality of life, and the importance of documenting one’s own healthcare decisions can help destigmatize death and appreciate the now. Getting together for the holidays often presents several openings for those important conversations, she said.

“If adult children are visiting from out of town, they may not have seen their mom or dad all year, and they might notice that their parent is not moving so quickly anymore,” Dr. Hamill said. “That could be an opening for such a conversation.”

Aging parents could also initiate the conversation by talking about the joys of past holidays, what gives their lives meaning, and how they’d want to spend their final days. Would they want to pass away peacefully at home surrounded by family and friends, or in a hospital room knowing that all available medical interventions are being attempted, regardless of the likely outcome?

Avoiding these discussions can lead to deeper anxiety, guilt, and suffering if a medical crisis occurs and families are called on to make healthcare decisions not knowing what their loved one might want. “You want to have (these) conversation when you don’t need it,” Dr. Hamill said. “The very worst time is in the ER when there is so much stress and pressure.”

Advance Directives and Other Documents

Surveys have shown that about 80 percent of adults believe it’s important to have advance care planning conversations, and yet only about 30 percent have actually done so and documented their wishes in an advanced directive. There are two main types of advance directive —a living will and a durable power of attorney for healthcare.

A living will is a legal document that specifies the type of medical care that an individual does or does not want if they are unable to communicate their wishes.

A durable power of attorney for healthcare is an official form that lets you name someone else to make decisions about your care in case you are not able to make those decisions yourself. It gives that person (called your agent) instructions about the kinds of medical treatment you want.

“In the state of California getting an advance directive is as easy as Googling,” said Dr. Hamill. “Although many people take care of this directive with an attorney while doing their estate planning, you don’t [really] need a lawyer or a notary.”

She added that it’s best to choose three persons for the advance directive—one primary person and two others who know you and can serve as witnesses to the document. “Your primary person (or agent) should give the form to your doctor, but your doctor should not be one of the three people (the primary person or witnesses.)”

Conversations Bring Families Closer

Many healthcare professionals pursue training in advance care planning and can help provide you with forms or facilitate conversations. Primary care providers are often a great resource, as are palliative care and hospice providers.

Robert Sawicki, MD, Vice President Clinical Services for OSF HealthCare in Peoria, Illinois, talked about the importance of advance care planning during the holidays in a recent article on the OSF website.

In the article, Dr. Sawicki said, “The most important thing is not to be afraid of (advance care planning). Talking about these things doesn’t make them happen; it does not create fear and anxiety so much…”

“When it’s done it’s actually a relief,” Sawicki said. “Thank goodness we were able to talk about this—and it actually brings families closer together and isn’t that what the holidays are all about?”

Homeland Hospice serves 14 communities throughout Central Pennsylvania by providing end-of-life care either in a person’s home or wherever they reside, including nursing facilities. Homeland can also assist with advance care planning.

To learn more, please contact at Homeland Hospice at (717) 221-7890.

Remembering Fallen Veterans: Homeland Hospice Participates in Wreaths Across America Day

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Every life has a story. These words are engraved on a simple stone at the entrance of the Dauphin County Cemetery, also known as Potter’s Field. The site serves as the final resting place for more than 800 unclaimed remains. World War II Navy Veteran Frank Bakanus, Jr., from Derry Township, is buried here. He is the only known veteran who has been identified and given a veteran marker on his grave.

On December 12, Frank and all of the unidentified veterans interred at the cemetery were remembered for their service during a wreath-laying ceremony led by Homeland Hospice. Hospice volunteers and staff placed wreaths and flags representing each branch of the military on the fence outlining the cemetery. Homeland Hospice is a hospice program that serves communities throughout Central Pennsylvania.

“Everyone buried here was someone’s son or daughter,” says Laurie Murry, volunteer coordinator for Homeland Hospice. “It’s our privilege to honor their memory and sacrifice.”

For the past several years, Homeland Hospice has partnered with Dauphin County for National Wreaths Across America Day held in December. Through the program, wreath-laying ceremonies are held at Arlington National Cemetery, as well as more than 1,600 locations in all 50 states, at sea and abroad.

The team at Homeland Hospice selected the Dauphin County Cemetery because of its similar mission and history with Homeland. One of the earliest markers at the cemetery is dated July 20, 1870. It began and remains a final resting place for individuals who have nowhere else to go.

“Compared to the larger public ceremonies, our time at the cemetery is somber and meditative,” says Homeland Hospice volunteer Phil Talarico. Phil and his wife Barb have participated in the project for the past several years.

Homeland’s story begins in the winter of 1866, in the aftermath of the Civil War. Battlefield casualties were not the only human losses of that conflict, as soldiers’ wives, widows and parents struggled to provide for dependent family members without the support of dead and disabled husbands and sons. Representatives from nine churches concluded that safe shelter for women and children was needed. The “Society for the Home for the Friendless” was formally chartered in May of 1867.

“My husband was a veteran,” says Lorna Owens, Homeland Hospice volunteer. “This project holds a very special place in my heart. I’m honored to participate.”

Homeland Hospice is a hospice program that serves 14 communities throughout Central Pennsylvania by providing end-of-life care either in a person’s home or wherever they reside, including nursing facilities. Homeland also provides bereavement support to families for a full 13 months following the death of their loved one. This service is available to anyone in the community who is experiencing grief.

To learn more, please contact at Homeland Hospice at (717) 221-7890.

Where do we begin?

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Authored by Buffie Finney, Clinical Liaison for Homeland Hospice, the following article was first published in the Fall issue of  “Central PA Medicine,” the official publication of the Dauphin County Medical Society.

I recently heard an all too familiar story about an 88-year-old gentleman I’ll call “William” whose life changed in a few short months after he began falling in his home. William went from living independently to assisted care after he was diagnosed with a debilitating illness. His mental and emotional state could not keep pace with his physical changes. William thoughtfully planned out his career and retirement, but never planned for long-term care. Like most of us, William didn’t want to consider the difficult decisions brought on by illness and advanced age. It’s enjoyable to plan a post-retirement vacation and frightening to plan for assisted care and our end-of- life journey.

As a clinical liaison for Homeland Hospice, I hear stories like this every day. Stories like William’s will continue to rise as the 65-plus age group outpaces other age groups in central Pennsylvania.

My advice to patients and families is to take it one step at a time. Like any journey, identify where you are today and where you can be in the near future safely. This may not be where the patient wants to be, but where he or she needs to be based on the diagnosis. This plan of care may continue to change depending on how the patient responds to factors like rehabilitation or the progression of the disease.

The first step is a life assessment with the patient, family members and physician to develop a care plan based on the patient’s diagnosis and realistic goals. This often occurs after a patient has been hospitalized. Hospital stays can be short, making the life assessment a critical step in planning a holistic treatment of care.

It’s not unusual for patients and families to be surprised to learn the patient will be discharged. Families may find comfort knowing their loved one is safe and cared for in the hospital and mentally put off making the difficult decisions about next steps. Often, patients and their families will make decisions based on what they want, like their loved one returning home, and not on their new reality. Without proper support in place, a hasty decision to return home could result in a fall or injury causing a repeat hospitalization and further decline in health.

Once the care plan is in place and implemented, the patient develops a new baseline or “new normal” based on the successful or unsuccessful outcome of treatment such as rehab or medications. In a best-case scenario, the patient will fully recover and can return to his or her home.

More often, the patient is facing greater physical and/or mental challenges and must face difficult decisions about acute or subacute rehab or hospice care. In my profession, I see this as a defining moment for patients and families. It’s an emotional and overwhelming time to learn and understand the impact of these choices. Often the decision is made in haste, as the patient needs to find a place to go upon discharge from the hospital.

Patients, families and their health care team want to try every possible opportunity to help the patient return to his or her former self. This often leads to acute rehab, which includes three hours of therapy a day to help patients reach this goal. This type of therapy is financially appealing as it’s a covered service by insurance providers.

Far too often, patients cannot keep up with the intensive therapy. When this happens, the insurance coverage ceases. Patients will be discharged to their homes or a skilled nursing facility to receive subacute care, which offers limited therapy. This type of care is private pay or paid by medical assistance.

Patients and their families are once again on the roller coaster of difficult decisions. The gravity of the patient’s age and disease progression settles in as does questions about affording long-term care. Most importantly, families must consider the quality of life of their loved one during this season of life.

As health care professionals, we’re the collective lifelines for patients and their families. We may not know all of the answers, but we know who to bring to the table to answer questions about prognosis, treatments and insurance coverage, among other important topics. This conversation may include the end-of-life journey through hospice care. The conversation can be difficult, but the benefits are immeasurable.

For patients who choose hospice care, it’s best to get started as soon as possible. Hospice provides a team of support to give families more time to absorb the emotional stress of their new reality. This is precious time for families to spend together as well as deal with any unresolved issues. Most importantly, the patient’s pain and symptoms are managed.

Homeland Hospice often assists physicians with end-of-life, advance care planning conversations. We also can be a tremendous asset bringing comfort, acceptance and peace to the terminally ill and their loved ones. Patients can receive hospice care anywhere they call home. This could be a residence or an assisted care facility.

Planning for the final steps in our journey or that of a loved one is overwhelming and emotional, but it’s not a journey anyone has to plan independently without professional guidance. No one needs to go through this alone. When a life assessment indicates a medical cure is no longer possible or the decision to stop aggressive treatment has been made, hospice may provide the most comfort and peace for patients and their families.

If you have any questions about Homeland Hospice, please contact us.